0015D13F.001

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   *    |   INTEGRATEO PLANNING ACT 1997                                                                                            Part A, Version 2.4, 29 May
             Land owner's consent {if appicable)       20.  Land owner’s consent to the making of this application:
           SE              ee afte appara     De             Pp               Name                      | Sionature                           |       ate
             Section 3.2.1(3) of the IPA prescribes that an
            written consent of the land owner!s, if the appfication .                                               AANA
            involves:                                          I                                                                                  5-
             () amatertal change of use;                     9 ROR              WIELSEN |                 a LDU. LN... 976-0)
             (9 reconfiguration of a fot                       7                                                           .
             7 makeioaon i             a       ees|          |       ST, MELEE |                            OMNI       CC aepnw.....0:6.0T
              7) work on land below high-water mark & not within a i                                              ,
             {4} work on rail corridor fand defined under the (iti)                                    /]
                Management Act 1995;0r                         .                                                                                            ---
                Transport infrastructure Act 1994.           noe e cee  eee cee eee ee ee cece eeceeeeeees    Pn wee eee cee eee ence ee beeen eee ee ee
             Section 3,8.1(2}(a) of the IPA provides that      .
            landowner’s consent is not required for a mobilg or {iv)
             For more information refer to Guide 1,            (v)
             Resource entitlement (if applicable)      21.  Does this application involve a State resource prescribed under a regulation (other than involving
             Section 3.2.1{5) of the IPA requires evidence of          ‘
                    ent      be glen for      that               ne       on State coastal land under the Coastal Protection and Management Act 1995)?
            involve a prescribed State resource.                  O - goto Q24                       (] YES - go to 022
            Section 3.2.1{10}(a)(@ of the IPA prescribes that  .      Lo,                  .         .
            application ‘cama be taken tbe propery made 22. This application is accompanied by evidence: (tick applicable box)
@            ve      en   ee                                1 (i)    of the allocation of, or entitlement to, the resource ~ attach evidence and go to Q23(v)
             Refer to schedule 10 of the intograted Planning (J (ii) the chief executive of the department administering the resource is satisfied the
             Regufation 1998 that prescribes the nature of evdenca                 i        i       '              i             ,
                 rod by the State fn support ofthe lndging of ths   development is consistent with an allocation of, or entitlement to, the resource ~ go
            development apptication.                             .         ;          .                             oo.                   .
                                                            (_] (iii) the chief executive of the department administering the resource is satisfied the
                                                                     development application may proceed in the absence of an allocation of, or
                                                                     entitlement to, the resource ~ go to Q23
             Adve foe completing 223 sndatory ttevdenoe 23.  Evidence of the resource entitlement:
              tear aes aS (nab              ences           (i)   Resource entitlement / authority   details            (vii) Official stamp of the department
            The official stamp of the Department of Natural                                                                  administering the resource (if
              Resources, Mines and Water ls mandatory where the .                                                            applicable,
              application involves any water or riverine quarry (ii) Name of delegated officer
              stort                                               Td
              Section 3.2.1(5A4) atows the eaouce reer ee
              the fime the eviden be used.      ust be       se       i:
                   sat {the evidence fine Tilted (a) m       (iii) Position of    a officer
                                                            {iv)  Ps of ~ officer
                                                             (v)  Date
                                                             (vi)   -_    date of evidence tees
              Assessment triggers                       24.   We                       Checklist completed and attached to this application?
              re   titin oPoe hee Botine rom oni   rs               Ss                   (L] NO - the assessment manager may refuse to accept this appication on the
              must be completed for all other applications,                                        grounds that the application has not been properly made
              Plans / drawings / reports                25.  Plans/drawings/reports accompanying this application:
              scan auger                   nceaee                   Pan/Oraving/Repor Number             | toate
             the application during public scrutiny or public (i) OT         WU—/                             é4|sor)              otrice |         fy    07
              manager, referral agencies and any person viewing .                                                  °              .         .
              oseromeaie                                      0 O7]/Ug                A... \Naliea Enleeticl                                         yer
             notification to understand the scope of the proposal wae Ee a    fe Re oe Loe wenn nnn          enn      han aa fon Denon nnn      Pe Rp
                                                               (iii)
                                                               (iv)
             a a
              PLEASE NOTE: The assessment manager may refuse to accept an application that, at the time of lodgement, fails to provide all applicable information required by Part A
                                and any other relevant part of Form 1.
      aa gg                                                 es
             OFFICE USE ONLY (applicable to assessment manager's,
                                                 DATE                           RECEIVING OFFICER'S | ¢7                        REFERENCE
              FEW      [Bee                                  3/40
                                                      Notification of Engagement of Private Certifier (Optionat form be
              To,                                                    Council. | have been engaged as the private certifier for the building work referred to in this application.
               Dateofengagement     /   /    AccreditationNumber_                     Name                                Signature;